Multiple sclerosis patients can learn to cope better with the fatigue, depression, and anxiety that often accompany the disease, researchers said.

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Multiple sclerosis is a variable disease and "mindfulness" training seemed to help with quality of life issues including depression.

Multiple sclerosis patients can learn to cope better with the fatigue, depression, and anxiety that often accompany the disease, researchers said.

In a randomized trial, patients with MS who took an eight-week course of "mindfulness" training improved their health-related quality of life significantly compared with people who had usual care for the disease, according to Paul Grossman, PhD, of the University of Basel Hospital in Switzerland, and colleagues.

The benefits waned over the following six months, but remained significant, the researchers reported in the Sept. 28 issue of Neurology.

The intervention was based on the idea that nonjudgmental awareness of moment-to-moment experience -- dubbed mindfulness -- can have positive effects on accuracy of perception, acceptance of intractable health-related changes, realistic sense of control, and appreciation of available life experiences, the researchers noted.

"MS is an unpredictable disease," Grossman said in a statement. "People can go for months feeling great and then have an attack that may reduce their ability to work or take care of their family."

Mindfulness training, he said, may contribute to a more realistic sense of control, as well as a "greater appreciation of positive experiences that continue be part of life."

To test the idea, he and his colleagues enrolled 150 patients with remitting-relapsing or secondary progressive MS and randomly assigned them to the mindfulness training or to usual care.

The primary endpoints were fatigue, depression, and quality of life, as measured by the Modified Fatigue Impairment Scale, the Center for Epidemiologic Depression Scale, the Hamburg Quality of Life Questionnaire in Multiple Sclerosis, and the Profile of Health-Related Quality of Life in Chronic Disorders, which is similar to the Short Form-36 health survey.

A secondary outcome was anxiety, measured on the Spielberger Trait Anxiety Inventory. All the assessments were done at the start of the trial, at the end of treatment, and after six months of follow-up.

The researchers found improvement on all outcome measures at eight weeks. Specifically, those in the mindfulness arm saw improvement on:

The Profile of Health-Related Quality of Life scale that was significant at P=10-5

The Hamburg scale that was significant at P=0.0002

The depression scale that was significant at P=10-5

The fatigue scale that was that was significant at P=0.0001

The anxiety scale that that was significant at P=0.0006

At six months, all the patients who'd had mindfulness training remained significantly improved, at values ranging from P=0.02 to P=0.001.

The findings suggest that such training can help patients cope with the nonphysical aspects of MS, Grossman and colleagues wrote.

But, they noted, the study lacked an active control group, so that it's possible some other factors -- such as motivation or the placebo effect -- might have played a role in the changes.

Indeed, that's the main limitation of the study, according to Jinny Tavee, MD, and Lael Stone, MD, both of the Cleveland Clinic.

Lacking such a control group, they argued in an accompanying editorial, the benefits "cannot be definitively specified for meditation." Indeed, a common limitation of many complementary medicine trials, they argued, is that "active participation in a treatment trial results in improvement due to an increased sense of coping."

Nonetheless, they said, the study is "solidly designed" and adds to the evidence that such approaches can be beneficial.

The study had support from the Swiss National Science Foundation, the Stanley T. Johnson Foundation, the Swiss Multiple Sclerosis Foundation, sanofi-aventis, Merck Serono, and Biogen-Dompé AG.

Grossman reported financial links with sanofi-aventis, Merck Serono, and Biogen-Dompé AG, and most other authors also reported links with industry.

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